Effect of asymptomatic severe aortic stenosis on outcomes of individuals aged 80 and older

• Autores: Atsuko Suzuki, Kazuko Tajiri, Tomoko Ishizu, Mio- Nakayama, Tomoya Hoshi, Seiichi Suzuki, Mikiko Hatsutori, Noriko Sato, Shingo Takayama, Mikihiko Kawano, Kazutaka Aonuma, Akihiko Nogami
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 9, 2018, págs. 1800-1804
• Idioma: inglés
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• Resumen

  • Abstract Objectives To examine the effect of asymptomatic severe aortic stenosis (AS) on mortality late in life.

    Design Retrospective cohort study.

    Setting Large medical center.

    Participants Asymptomatic adults aged 80 and older (mean age 86 ± 4; N=1,060, n=569 women) with preserved left ventricular ejection fraction (LVEF; > 50%); 927 (87.5%) with no AS, 70 (6.6%) with nonsevere AS, and 63 (5.9%) with severe AS.

    Measurements Information was collected on demographic characteristics, comorbidities, and laboratory and echocardiographic data. Survival was assessed according to longest follow‐up available.

    Results During a mean follow‐up of 2.2 ± 2.3 years, there were 203 (19%) deaths, 51 of which were from cardiovascular causes. Four‐year estimates of survival were 72% for no AS, 58% for nonsevere AS, and 23% for severe AS (p<.001). Univariable analysis showed that asymptomatic severe AS was significantly associated with greater risk of all‐cause mortality (hazard ratio (HR)=3.06, 95% confidence interval (CI)=1.96–4.58, p<.001). After adjustment for age, sex, LVEF, hypertension, dyslipidemia, diabetes, atrial fibrillation, chronic kidney disease, and coronary artery disease, asymptomatic severe AS was an independent predictor of all‐cause mortality (HR=3.16, 95% CI=1.97–4.88, p<.001).

    Conclusion Asymptomatic severe AS has a major effect on prognosis even in very old adults.